The Ritalin Wrangle

As a very young child, Joseph Welch was extremely active and at times difficult. His mother, Cindy Welch, at first thought he was just “being a kid.” But then he started having trouble completing school assignments. In 2nd grade, his teacher in his public school in Newburgh, a Hudson River town 70 miles north of New York City, suggested that a doctor evaluate him for attention deficit disorder. The diagnosis was negative. But by the end of 3rd grade, it was clear there was a problem. Evaluated again, Joseph this time showed signs of ADD, and at the age of 7, was prescribed Ritalin, the brand name for the stimulant methylphenidate hydrochloride, a drug used to control the disorder.

Joseph’s story is typical of the progression of diagnosis and treatment of children with behavioral disorders. An estimated 2 million school-age children in the United States have been diagnosed with ADD or the related ADHD, attention deficit hyperactivity disorder. These are the most commonly diagnosed behavioral disorders in America, according to the National Institutes of Health. Meanwhile, prescriptions for Ritalin to treat the disorders spiral upward-260 percent from 1992 to 1997.

Despite the rampant growth in the number of kids identified with ADD or ADHD and the use of Ritalin to treat them, there continues to be no specific or conclusive medical test to identify the disorders. While the medical community lacks generally accepted methods of diagnosis and follow-up for children, the widespread use of Ritalin has heightened concerns about its abuse. This state of affairs, concludes NIH, is “a major public-health problem.”

It is also a problem that troubles parents like Welch and has them looking for answers outside of conventional medical treatment. Her decision to dose Joseph with Ritalin was a reluctant one: “I didn’t feel we had a choice,” she says. Then Joseph had a mixed reaction to the drug. He became more alert in class but suffered headaches, weight loss, mood swings, and sleeplessness. The pill Joseph took twice a day made him “feel weird,” he says. Like a growing number of parents, Welch took her son off the drug and turned to alternative remedies such as herbal and homeopathic preparations, bio feedback, diet management, and behavior modification-treatments that worry the medical community, which regards them as experimental and not well researched.

But traditional medicine offers little in the way of conclusive data about the disorders and has done little to quell critics who question whether ADD even exists or who assign its origins to faults in society, not biology. Research on treating ADD suggests that Ritalin works well in the short term, according to George DuPaul, a professor of school psychology at Lehigh University in Bethlehem, Pennsylvania. (Researchers have yet to examine the benefits and risks of any drug used to treat ADD or ADHD beyond a 14-month period.) DuPaul is in the midst of studying early-intervention programs for children ages 3 to 5 who are at risk for ADD-in other words, who display inattentive, impulsive, or aggressive behavior. So far, preliminary results show that children who take part in such programs have less severe symptoms of ADD and are less aggressive.

But DuPaul, like others, questions whether prescribing medication alone does enough to address the academic and social problems associated with ADD. Dr. Lawrence Diller, a behavioral pediatrician and author of the book Running on Ritalin , agrees. The increase in the diagnosis of ADD is a reflection of a “living imbalance rather than a chemical imbalance,” he says. “The demands on children have increased, but the social supports for them have decreased. I have no doubt that Ritalin works in the short term, but I don’t think it is the moral equivalent to more appropriate parenting and better schools for our children.”

In the meantime, parents feel there is no place to turn for answers. The nonprofit advocacy group Children and Adults With Attention Deficit Hyperactivity Disorder, known as CHADD, is skeptical of alternative treatments and says medication and behavior modification are a better bet. But the group has been criticized for accepting donations from Novartis A.G., formerly Ciba-Geigy, the manufacturer of Ritalin. CHADD President Mary Robertson says drug companies have no influence on the group.

For Cindy Welch, treating Joseph’s ADD with diet management-no sugar or dairy products-and homeopathy, in which plants, minerals, and other natural substances stimulate the body to heal itself, appears to be paying off. Now in 4th grade at the private Bishop Dunn Memorial School, Joseph has taken up a hobby his mother never thought possible: building model airplanes. “He sits for hours [working on the models],” Welch says. “For someone with ADD, it’s a great improvement. I look at Joseph’s overall health and know I made the right decision.”

Others, like Bonnie and Jay-parents who asked that only their first names be used in this story-still struggle with their decision. Their 11-year-old daughter, Nicole, was diagnosed with ADHD at the age of 5 and has been on Ritalin since. For the second time in two years, they recently tried to give her a break from the drug, only to return to the regimen. The treatment has presented the family with a dilemma. The first time they stopped the medication, in 3rd grade, she was back on it within three days. A few months ago, they tried again, but she lasted a week. During that time, she was livelier and more personable but also more fidgety, her mother says. On Ritalin, Nicole is calmer but “edgy and grumpy after school.” Her parents worry about how the medication can distort her personality. “I hate the thought of losing one thing to gain another,” says her mother.

Faced with insufficient scientific research on the medical and social implications of the disorder-but with only one accepted medical treatment for ADD and ADHD-Bonnie and Jay may have little choice.

--Adrienne D. Coles